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FOR OFFIC USE: APPLICATION FOR SANITATION PERMIT Permit No. -___--..?._... ---------------- ---------- I Date (Complete in Duplicate) Issued . ...... ........ ----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work berein described. This application is made in compliance with County Ordinance No. 549. "*e -1 JOB ADDRESS AND LQATION.__.�0� #1l.__ lnrI�� l�_--_1l�fiGG___.... _ 'tP�.O. .tXL�.��d! �2-!�............. , iO ••-- Owner's Name---• -- --------- -------------- Phone.................................... Address----------•- 1j1✓�------- --------------------------------------------------•---------...-----------.............. Contractor's Name--------- - -------------------------------------------------------------------------•-------------------- Phone................................... . Installation will serve: Residence g��Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./._ Number of bedrooms 2.. Number of baths/4.. Lot size .�f��„!�._��1•.......................... Water Supply: Public system E] Community system C] Private 23"-Depth to Water Table A0. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: (if yes,date--------------------) No 2,' New Construction: Yes 93,"No ❑ FHA/VA: Yes ®—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__.f_4------Distance from foundation....10----------Material...Z1. . No. of compartments------s2---------------Size..,d-4yX__ ',___Liquid depth_..�y'...........Capacity...&.4l....... Disposal Field: Distance from nearest well---4'77-_-_._Distance from foundation__/.._.__.......Distance to nearest lot line..._...... ®_1_ Number of lines............... .. Length of each line____ ..-� Width of trench ----- Type of filter material. ._% 'y r yp ��Depth of filter matenal____`�_____._.__.Total length_____�.��____________-_----_-- Seepage ___________See a e Pit: Distance to nearest well----/��-____--Distance from fo ndation.....10........Distance to nearest lot line...11A~......... Number of pits....A--------------Lining material.XPO� -..Size: Diameter-__---s2df........Depth._A.0. �....._.........._ Cesspool: Distance from nearest well.................Distance from foundation_....---.._-___,-__.Lining material.......... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.......................................... ❑ Distance to nearest lot line--------------------------------------------------------- ----------------------..................................... and/or repairing (describe):----------------� __e - ---------...:_.._.._._...........•-••-•-•••••-•--•-•---•••. -------•--------•-----------------------------------------•------------------•-------------•--------------------------------------------------------------•------------------------------•-•-----------•----------------•- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Distfict. (Signed)----------------`--.ea. --- --- r Contractor) By:-•••••••••••••••-••••----•••-•••--•--••••...............•- ••- --- •....(Title)._'. '.............................. (Plot plan, showing size pf lot,location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART E T USE ONLY APPLICATION ACCEPTED BY ----- DATE - ��` �� REVIEWEDBY--------------------------------------------------- --- -------------------------------------------------------------------- DATE........................•.................................. BUILDINGPERMIT ISSUED...........«................ -------------------------------...................................... DATE............................................................. Alterat' a /or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------••-•-•... c -----------------------•------- ------•----•-------••----------- ------------------------------------------------------ ............................ -••-••--------•-----•••----••-••--•--•----••------••-•-•--••-•-----•...---------------........-------- FINAL INSPECTION BY:.--- --- ------- ------ ------------- Date----------�le?.....141-- --- -_.... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore Street 205 West 9th Strew- -- Stockton,California Lodi,California Manteca,California Tracy,California to 0 REVISED 6-89 2M_j-6l ATLAS